Introduction Instituted forty years prior to the US’s formation, the Bellevue Hospital of New York City is the first public hospital of the nation, constructed even before medicine became a profession, on the piece of land presently housing the City Hall. Currently situated along a First Avenue stretch, its first building accommodated six beds. The hospital’s history reflects the city’s ongoing transformation, besides recording the nation’s medical education. With regard to illness, the major part of US public health policy may be traced directly back to Bellevue hospital. While its name is ‘infamous’ for mistreatment and mental treatment- related horrors, Bellevue has, at all times, cared for patients presenting with more physically apparent illnesses. Typically the last resort for those at the end of their tether, this hospital has endured outbreaks of tuberculosis, typhus, pneumonia, HIV, polio, yellow fever, and the flu, carried by its poverty- ridden patients. New York City has contributed significantly to how hospitals function in the present day, being the entrance point for migrant waves (Gordon, 2016). In this paper, a detailed SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis of the city’s Bellevue Hospital will be undertaken.

STRENGTHS

BHC (Bellevue Hospital Center) represents the earliest continuously operating healthcare center of the nation, first instituted in the year 1736. It enjoys an illustrious history of making groundbreaking public health, health education and medical science contributions. A member of NYC’s HHC (Health and Hospitals Corporation) which is the biggest system of public hospitals in America, Bellevue is affiliated with New York University’s medical school and delivers a variety of out- as well as in- patient medical, psychiatric and surgical services. Moreover, other healthcare practitioners and clinics across the city widely refer extremely complex cases to this hospital. Dignitaries who visit the city (including UN diplomats and the US President) receive healthcare services at its facilities. Present BHC facilities incorporate an 800- bed, 6- ICU, 24-storey healthcare facility with a 4-storey state- of- the- art Ambulatory Care Pavilion and world- famous Emergency Service and Trauma Center. It is regarded as the HHC’s “flagship”; HHC, a 6.7- billion- dollar public benefit organization and the nation’s biggest municipal healthcare institution, aims at providing superior- quality, holistic healthcare to every patient irrespective of his/her paying capability in an environment of respect and dignity. This integrated system of care delivery offers medical, substance abuse and psychiatric health services via eleven acute care centers, 4 skilled nursing centers, over 70 community clinics and 6 large diagnostics/therapy centers. Further, HHC’s Health and Home Care offers local communities in- home services (Pressman & Bohlen, 2013).

Ever since the days of its humble start as a refuge for New York City’s destitute population, the Bellevue Hospital has served as a globally- recognized, key academic medical organization. Over time, it has functioned effectively as the incubator for important public health, medical education and medical science innovations. Referred to frequently as one of the nation’s ‘treasures’, this hospital effectively defines the best public medicine traditions in the form of a critical public service for societal wellbeing. Bellevue’s competent, high- tech Emergency department, which is one among the biggest in New York City, and its Trauma Center (Level I) offer 24/7 holistic care in pediatric, adult, pediatric psychiatric and psychiatric emergencies, besides the nationally- identified categories of neurology, cardiology, neonatology, and toxicology. The hospital is home to one among the top cardiovascular initiatives of New York State, with its “door to St- Elevation Myocardial Infarction (STEMI)” time going far beyond national recommendations. New York City’s Health + Hospitals/Bellevue has, for long, remained the pioneer when it comes to identification and categorization of mental conditions, and the training of psychiatric nurses and psychiatrists (NYC Health Hospitals/Bellevue, n.d.).

The hospital has effectively defined practice standards for micro- surgically replanting hands, limbs and fingers, besides spinal cord and brain injury microsurgery. Its initiative on Geriatric Ambulatory Care is one of America’s largest, with over 5,000 seniors being cared for on an annual basis. In the area of perinatal care, the hospital represents the Regional Perinatal Center (RPC) for eleven hospitals that form part of the system. It offers up- to- date,...

Its high- risk obstetrics clinics guarantee top- quality holistic primary, gynecological and obstetrical care to both mom and baby. Its obstetrics services include rooming- in, midwifery- based deliveries in low- risk cases, and high- risk obstetrics area for dealing with highly complicated child- birth cases (NYC Health Hospitals/Bellevue, n.d).
WEAKNESSES

Hospitals offer wide- ranging outpatient care. However, each year, several thousand individuals, a large number of them underinsured and poverty- ridden, continually seek medical assistance at emergency departments providing hardly any personalized attention to patients and barely skimming the surface of social issues which result in their ending up in those situations. Obamacare brought about an increase in the number of insured as well as lowered uncompensated care costs for hospitals including HHC. Still, roughly 700,000 inhabitants of New York remain uninsured. Taking into account its mission, the HHC will probably continually contribute in a significant manner to caring for uninsured populations. The financial approaches adopted for supporting its mission include retention of existing sources and promotion of reasonable division of responsibility for uninsured groups between voluntary facilities and the HHC. The latter ought to advocate for existing state funding sources and tax exemptions that are conditioned on increased voluntary hospital engagement in uninsured patients’ care (Kellermann, 2015).

A second weakness is: an absent rational financial bond with New York City. Municipal leaders and the HHC ought to come up with more stable, reasonable HHC financing guidelines. The novel strategy ought to bring about improvements in the financial stability of HHC, its long-run fiscal planning capability, and its economical service delivery incentives. Some of the possibilities are capitated payments in case of uninsured patients reflecting care provision costs and paying incentives for adopting up- to- the- minute models of care management. HHC constitutes a highly salient resource for NYC, rendering its financial sustainability critical. For enjoying success in the swiftly evolving healthcare landscape, the HHC’s operations require modernization. Service restructuring for financial stabilization ought to be one among the top priorities for local and state leaders (Kellermann, 2015).

Though the HHC mission’s financial burden has forever been a constant challenge, Obamacare and the 2008 economic crisis have negatively affected its financial health. Non- paid care reimbursements by the federal government have been cut down heavily, leading to a five- hundred- million- dollar worth loss in only the last few years. On the whole, the HHC has, up until now, experienced an over- 554- million- dollar loss in annual Medicaid financing due to state budget actions in the last 5 years. Massive federal and state funding cutbacks, accompanied by sharp growths in healthcare expenditure and increasing numbers of uninsured and unemployed patients, have led to the creation of a forbidding fiscal burden for the HHC. Other elements that affect it financially are the sharp increase in pension costs which are currently over 435 million dollars annually, and the close- down of a large number of area hospitals that used to treat the same underprivileged population the HHC caters to, resulting in a considerably greater demand for the services Bellevue Hospital offers (New York City Health and Hospitals Corporation, 2014).

OPPORTUNITIES

Over two decades back, the HHC started making use of EMRs (electronic medical records) for tracking patient data. In the last ten years, IT has served as a valuable instrument in improving how staff members – among and within facilities – collaborate and share information relating to patient care with one another. But the present EMR system increasingly lacks advanced functionality vital to sharing organization- wide information broadly and meeting the current provider and patient needs. In the year 2012, HHC’s executive board sanctioned EPIC’s purchase (EPIC is a powerful novel EMR system and the leading EMR system provider in the industry). EPIC’s adoption will serve to bring about patient care improvements through providing comprehensive, timely patient EMR access and supporting provider engagement in more informed decision- making whilst simultaneously safeguarding patient confidentiality. Additionally, EPIC will encompass clinical reminders and notifications, improve choice of therapeutic approach, improve quality improvement monitoring and research, and offer inbuilt safeguards against therapies potentially linked to adverse events. HHC’s clinical workers,…